453-03-3595-m2
DECISION AND ORDER Neuromuscular Institute of Texas, P.A. (Provider), appealed the decision of an Independent Review Organization (IRO) upholding the denial of preauthorization for ten additional chronic pain management (CPM) sessions for an injured worker (Claimant). In this decision, the Administrative Law Judge (ALJ) finds that Provider met its burden of showing that the requested […]
453-03-2985-m2
DECISION AND ORDER A 36-year-old workers’ compensation claimant suffered a work-related injury on________, when her employer had workers’ compensation coverage with the Carrier, Zurich American Insurance Company. Her physician, M. Lewis Frazier, M.D. (Petitioner), requested preauthorization for a discogram. The Carrier denied the request, and the independent review organization (IRO) reviewer found the test was […]
453-03-3236-m2
DECISION AND ORDER STAT 2000 challenges the decision of the Independent Review Organization (IRO) denying preauthorization for the purchase of a neuromuscular stimulator for an injured worker. (Claimant).[1] After considering the evidence and arguments, the undersigned Administrative Law Judge (ALJ) finds that STAT 2000 has shown, by a preponderance of the evidence, that the requested […]
453-03-3620-m2
DECISION AND ORDER I. Summary __________ (Petitioner or Claimant) sought review of a decision by the Medical Review Division (MRD) of the Texas Workers= Compensation Commission (TWCC or Commission) declining to preauthorize a chronic pain management program (CPM) to treat her injury. The substantive review of Petitioner’s claim was conducted by an Independent Review Organization […]
453-03-3348-m2
DECISION AND ORDER John A. Sazy, M.D. (Petitioner) is appealing the decision of Ziroc, an independent review organization (IRO) denying preauthorization for an MRI. The IRO determined from the medical documentation submitted for review that the requested medical procedure was not medically necessary to treat the Claimant’s condition. The Administrative Law Judge (ALJ) finds the […]
453-03-2915-m2
DECISION AND ORDER STAT 2000 appealed the decision of the Texas Workers’ Compensation Commission’s (Commission) designee, an independent review organization (IRO), which denied preauthorization for the purchase of a neuromuscular stimulator for Claimant. After considering the evidence and arguments, the undersigned Administrative Law Judge (ALJ) finds that STAT 2000 has not shown, by a preponderance […]
453-03-3030-m2
DECISION AND ORDER This case involves the appeal by Maximum Therapeutic Initiative, LLC (Petitioner), from the decision of an Independent Review Organization (IRO) that denied a request for preauthorization for work conditioning for six weeks. The decision agrees with the IRO, finding the injured worker (Claimant) has had previous work conditioning and ample time to […]
453-03-1180-m2
DECISION AND ORDER John A. Sazy, M.D., appealed an Independent Review Organization (IRO) decision denying preauthorization for Claimant to receive an EMG of the lower extremities and a lumbar discogram with CT scan. The IRO concluded that these tests were not medically necessary. This decision agrees with the IRO and concludes that the tests are […]
453-03-2173-m2
DECISION AND ORDER This case concerns a request for preauthorization for a workers’ compensation claimant (Claimant) to participate in a chronic pain management program. The Administrative Law Judge (ALJ) concludes preauthorization should be granted. I. Discussion The Claimant incurred a compensable back injury_________. He underwent a lumbar fusion in December of 1999, and has received […]
453-03-3346-m2
DECISION AND ORDER Texas Mutual Insurance Company (ATexas Mutual) challenges an Independent Review Organization (AIRO) decision approving preauthorization for bilateral facet injections and trigger point injections to be performed by Respondent Donald Kramer, M.D. on ____ (Claimant). The Administrative Law Judge (AALJ) finds that (1) the request for preauthorization should be dismissed for lack of […]